The State of Chinese Health Will Bring Attention to the Social Issues and Healthcare Needs of Our Community

2 “Most people think that the Asian community is prosperous. But the majority of our people are working class, middle class and low-income. The State of Chinese Health will bring attention to the social issues and healthcare needs of our community. Chinese Americans are often misunderstood; it is important to New York for us to be understood.” — Henry Chen, MD, President of SOMOS 6 7 MISUNDERSTOOD THE STATE OF CHINESE HEALTH IN NEW YORK CITY 10 MISUNDERSTOOD THE STATE OF CHINESE HEALTH IN NEW YORK CITY New York City is home to the largest Chinese population with the doctors that serve Chinese New Yorkers, as well outside of Asia. Today, the greater New York metropolitan as existing research and public data. In Chinese, there is an area boasts over 800,000 Chinese residents—16% of expression of “simplifying what is complicated” ( 化繁為簡). the entire US Chinese population.1 The city’s numerous Through The State of Chinese Health in New York City, we Chinatowns continue to be a thriving and vital part of the strive to untangle the web of misperceptions that adversely community, fueled by constant flows of immigration. impact Chinese New Yorkers’ health so that we can get to a place of harmony, balance, and good health. In the bustling streets of Manhattan’s Chinatown or Brooklyn’s Sunset Park, the Chinese knot—which through This study is part of SOMOS’ broader effort to gain a its symmetry and feng shui, symbolizes good fortune comprehensive understanding of the general state of health and health—commonly hangs on lampposts, awnings, of the populations we serve throughout New York City. and doorways. Yet, despite the ubiquity of the symbol, SOMOS is a non-profit, physician-led network of nearly the health of Chinese New Yorkers can be described as 3,500 community health providers in the Bronx, Brooklyn, anything but harmonious. Even with their rapidly growing Queens, and Manhattan, serving primarily immigrant and evolving presence, the Chinese community’s diversity communities of all ethnicities and ages—200,000 of whom and unique cultural challenges are often overlooked, are Chinese. oversimplified, and misunderstood. This belies the real The State of Chinese Health in New York City serves as a roadblocks they face relating to fundamental needs—the companion piece to The State of Latino Health in New York most important of all being their health. City. Similar to The State of Latino Health in New York City, This report aims to fill in this knowledge gap. Our research our goal is to inform key stakeholders and policymakers includes a first-of-its-kind, city-wide survey and in-depth at the city, state, and federal level of the challenges that interviews of Chinese New Yorkers, both of which were Chinese New Yorkers face. We hope this report will help conducted in Chinese, allowing our Chinese respondents identify solutions that will improve access to healthcare and to answer in the comfort of their own language and in their promote a greater quality of life for Chinese New Yorkers own homes. Our study integrates the conversations we had and the vibrant communities in which we live. 11 BUILDING THE CASE FOR MORE CULTURALLY-RICH HEALTH RESOURCES AND DELIVERY OF CARE Despite its rapid population growth and having a rich, In-depth interviews of Chinese patients and a focus group centuries-old history of living and working in New York City, with their doctors reveal how cultural misunderstanding the Chinese community is one of the most vulnerable and often leads to lack of compliance with medical advice, underserved segments in the city. Nearly 20% live under the denial of illness, and overall misalignment between doctor poverty line, a third lack citizenship, and nearly two-thirds and patient. deal with language barriers.2 This serves as important 3. Despite being underserved and lacking sufficient context to understanding their general state of health. culturally-relevant health resources, ideal health conditions Our key findings include: for Chinese New Yorkers are within reach. 1. Chinese New Yorkers are not as healthy as they think • Over 90% have healthcare insurance they are. Nearly 80% believe they are in good health and • 70% have a Chinese-speaking primary doctor have a healthy lifestyle—and yet: • 65% of Chinese New Yorkers visit their primary • 70% report that they have been diagnosed with a health care doctors often condition, with a sizable number having hypertension, • Over 50% have a positive outlook on the depression, and diabetes healthcare system • Only 52% say they don’t smoke Chinese New Yorkers who behave and feel this way • Only 43% say they watch their diet carefully generally have access to more resources such as established This contradiction strongly suggests Chinese New Yorkers in-language community support, a Chinese-speaking are downplaying their conditions—likely resulting in more primary doctor, and cost-effective care. Increasing these fatal conditions in the future. Indeed, lung cancer, heart factors can tip the scales from being a community rife with disease, diabetes, and suicide fall within the top 10 causes misperceptions and disparities to a model of great health. of mortality for Chinese New Yorkers. 2. Communication issues are an enormous health barrier, but it goes beyond speaking the same language. For health providers, it’s also about being fluent in their culture. For Research Methodology: Chinese New Yorkers, it’s about being health literate. • City-wide survey of 300 respondents that represent the • Over 60% have limited English proficiency demographic profile of the Chinese population living in New York City (conducted in Chinese and English) • 54% say most healthcare providers do not share their culture • In-depth interviews of four low-income, Chinese-language dependent Chinese residents to gain deeper insights from • 50% say they still don’t understand what their doctors at-risk, harder-to-reach patients (conducted in Mandarin) are saying even when the doctors speak Chinese • Focus group of 10 doctors that serve Chinese communities in New York City 12 13 CHINESE NEW YORK UNDERSTANDING A GROWING, BUT VULNERABLE COMMUNITY CHINESE NEW YORK UNDERSTANDING A GROWING, BUT VULNERABLE COMMUNITY Coined in the 1960s, the term “model minority” was used the greater Flushing area as Mandarin was the lingua franca. to describe Chinese and other Asian Americans as a More affluent segments crossed the Queens border to well-educated, healthy, and prosperous group with fewer Nassau County. problems to be addressed. While the “Model Minority Myth” Sunset Park, Brooklyn is often referred to as “Little Fuzhou” has since been debunked countless times by social scientists for its large population of Fuzhounese immigrants who and activists, it remains a persistent and injurious trope. sought more affordable housing compared to what existed This section aims to provide a nuanced portrait of Chinese in Manhattan’s Chinatown area. A large number are New Yorkers to fully understand and unpack their health undocumented and are employed in low-paying occupations. challenges and needs. The Chinese population has since expanded across the southern part of Brooklyn, from Bay Ridge to Coney Island.3 A PATCHWORK OF New York’s Chinatowns continue to be vibrant, ever-evolving CHINESE IMMIGRATION communities, extending well past their original borders and The diversity of the Chinese population in New York can giving rise to new satellite Chinatowns nearby ( Figure 1 ). be understood through the history of New York City’s Figure 1. New York’s Official and Unofficial Chinatowns Chinatowns. In the late 19th Century, Chinese immigrants trickled slowly into Lower Manhattan following growing anti- Chinese sentiment and the decline of mining in the Western BRONX states. The anti-Chinese sentiment culminated with the 1882 Elmhurst Flushing Bayside and Little Neck Chinese Exclusion Act, which was not lifted entirely until the MANHATTAN passing of the 1965 Immigration and Naturalization Act. Chinatown Forest Hills Following the 1965 Act, Manhattan’s Chinatown saw an influx QUEENS of Chinese immigrants, mainly Cantonese speakers from BROOKLYN Hong Kong and Guangdong Province. The post-1965 period Sunset Park also brought in a large number of Taiwanese immigrants, STATEN ISLAND who mainly spoke Mandarin and had the benefit of higher Bensonhurt educational and socioeconomic status. Having little in Homecrest common with their Manhattan counterparts, they chose Flushing, Queens as their home. Later and larger waves Source: Stephanie Tuder, “Believe it or not, New York City has Nine Chinatowns” Eater New York, February 25, 2019; Matthew Bloch, et. al, “Mapping Segregation,” coming from Mainland China also opted to settle around New York Times, July 8, 2015 16 17 A GROWING BUT VULNERABLE MARKET Today, at an estimated 661,854 living in New York City Limits, Based on 2017 US Census estimates, nearly 20% of Chinese the Chinese population is the fastest growing segment in New Yorkers fall below the poverty line. Among those aged New York City, growing by 50% since 2005 ( Table 1 ). 65 and above, the percent impoverished jumps to 30% The Chinese segment is also the largest Asian group in the compared to 18% for the elderly in New York City overall city, making up about half of the Asian population in New ( Figure 2 ). The neighborhoods with the largest Chinese York City.4 populations have higher poverty levels: the poverty rate in Manhattan’s Chinatown is 28% and the poverty rate in Statewide, Chinese New Yorkers have $16.4 billion in Brooklyn’s Sunset Park is 26%—both well over New York spending power and contribute $2.6 billion in state and City’s poverty rate of 21% ( Table 2 ). Moreover, about local taxes.5 In aggregate, Chinese New Yorkers’ wealth two-thirds lack English proficiency and a third of the Chinese appears to be just below that of New Yorkers overall.

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